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ACE (Tritace) for my Non-Obstructive HCM

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Pinoy Bill Find out more about Pinoy Bill
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  • ACE (Tritace) for my Non-Obstructive HCM

    I've read articles that ACE is used to treat HCM. Some of you here have experiences that ACE was discontinued because they we're diagnosed of having HCM. Presently Im taking Tritace 1.25 mg, could you please post your opinion and experiences here?
    ***Let the beat go on***

  • #2
    I don't know your specifics but usually all ACE inhibtors aren't used in HCM because they cause the heart to beat more forcefully and the "normal" HCM heart beats too forcefully already. There are times when ACE's are used for individuals and it's the right call, but usually when it's used in HCM it's because the physician is'nt very up-to-date on HCM and what all it entails. I hope this helps answer your questions. I'm sure others will post their experiences and thoughts soon.

    Reenie
    Reenie

    ****************
    Husband has HCM.
    3 kids - ages 23, 21, & 19. All presently clear of HCM.

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    • #3
      HCM treatment needs to fit the patient and symptoms. The variation between one HCMer and another can range from almost no symptoms to needing a new heart!

      The Mayo Clinic writes: Inhibition of the tissue RAS via intracoronary infusions of ACE inhibitor can improve diastolic properties. However, systemic administration has not been widely studied. Caution must be taken prior to commencing therapy with antagonists of RAS (ACE inhibitor, angiotensin receptor blocker, etc.) that the patients have no resting or inducible outflow gradient. The afterload reduction that is produced by these agents can exacerbate the obstructive tendency, and counteract any gains made in diastolic function. Drugs, which slow or blunt the heart rate, can facilitate left ventricular filling by maintaining an adequate diastolic filling period. Additionally, low-dose diuretics can be useful adjuncts in non-obstructive HCM.

      In English, that means that if you do NOT have an obstruction, ace-inhibitors are not a good idea.

      Ace-inhibitors are more often used in dilated cardiomyopathy.

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      • #4
        I would like to make a difference between using ACE inhibitors and AT1-receptor blocker. The two meds acts differently in RAS. While ACE inhibitors modulate the RAS at the level of the ACE enzyme, the AT1 receptor blocker offers a selective blockade only at the angiotensin II type 1. It's known also that angiotensin II modulate the collagen production in the heart muscle. The Ang type 1 (AT1) acts with pro-fibrotic effect (increasing collagen's production) and the type 2 (AT2) with anti-fibrotic effect (inhibiting collagen's production). HCM is mainly a diastolic disease with interstitial fibrosis (collagen plates among the myocyte cells). The Brazilian Heart Institute is developing an study with non obstructive HCM patients since 2002 using an AT1 receptor blocker (losartan). The results until now are promising. Here are some data before and after the treatment:

        - The NYHA functional class reduced from 2,04±0,81 to 1,48±0,64;
        - The left atrial diameter reduced from 43,3±6,2mm to 40,5±6,1mm;
        - The atrial reverse flux reduced from 36,4±9,7cm/s to 32,2±6,2cm/s;
        - The average NT-proBNP reduced from 1238 pg/ml to 910 pg/ml;
        - The patients has not changed the outflow gradient at exercise until now, i.e., they keep non obstructive (with no resting outflow gradient).

        While these numbers are experimental and the AT1 receptor blockers (like ACE inhibitors) also promote the peripheral vasodilatation and afterload reduction that could contribute to the (theoretical but not confirmed) obstructive tendency, they are being used with caution here in Brazil.

        If the fibrosis reduction has been totally confirmed (the MRI is being used to check this), it won't only a matter of diastolic function improving and symptom relief but effective treatment to one of the HCM base problems. At some point would be necessary to evaluate this risk against the theoretical side-effect of contributing to the obstructive tendency.

        William.

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        • #5
          Originally posted by Sarah
          Ace-inhibitors are more often used in dilated cardiomyopathy.
          ...and HCM hearts in the "end-stage" or "burned-out" phase of HCM are treated like dilated cardiomyopathy.

          There may be a good reason for taking an ACE inhibitor (or maybe it is truly a mistake). Discuss this with your physician!

          Best Regards,
          Rob Thomas
          --Living life on the edge .. of a continent!
          Charter member: Tinman Club

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          • #6
            Thanks guys, i would surely discuss this matter to my cardiologist.
            ***Let the beat go on***

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            • #7
              ***Let the beat go on***

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              • #8
                ACE inhibitors in non-obstructive HCM

                Hi Pinoy,

                I don't know whether you are still on this medication. My cardiologist hast started me on ACE inhibitors in July. It has worked for me in the sense that I have not had any episodes of atrial fibrillation. I have, however, other symptoms that I did not have before, I think, though, that they are probably more related to the progression of my disease than to the ACE.

                Since we have the same condition, tell me about you. What are your symptoms, how are you coping in general?

                Look forward to hearing from you.

                Jutta
                51 years old, non-obstructive HCM, diagnosed at 27, severe symptoms since 2005.

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